Baker, Timothy Michael NEW YORK STATE DEPARTMENT OF HEALTH (� - iJ
Bureau of Vital Records ,< Burial - Transit Permit
Name First Middle Last Sex
Timothy Michael Baker Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/02/2022 61 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Warrensburg Town Street Address 91 River Street A,Warrensburg Town, New York 12885
'p Manner of Death MNatural Cause Accident ❑Homicide Suicide Undetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
O Lynn Keil PA
Address
1340 State Route 9,Lake George Town, New York 12845
Death Certificate Filed Town Of Warrensburg District Number Register Number
City,Town or Village 5660 19
Burial Date Cemetery,Crematory or Facility Name
11/12/2022 Pine View Crematory
Entombment Address
aCremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
F Hold Address
0
a Date Point of
U) Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/11/2022 Registrar of Vital Statistics rPaine&a M Lloyd(Electronically Signed)
(signature)
District Number 5660 Place Town Of Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition II/iL f 2 L Place of DispositionG-1t2--
(address)
W
cc N (section) (lot number) (grave number)
O Name of Sexton or Person in Charge o Pr ises "'
Z (pease print)
W Signature Title Izolnvt
DOH-1555(07/18)p 1 of 2
016398
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named pn burial permit
Official Funeral Directors Reg. or License#